Optic Nerve Sheath Ultrasound As A New Marker For Predicting Outcome Of Patients With Acute Ischemic Stroke

Background: Increased intracranial pressure（ICP）is associated with poor outcomes following acute ischemic stroke（AIS）.ICP has been confirmed to be correlated with ultrasonographic optic nerve sheath diameter（ONSD）and transcranial Doppler（TCD）parameters.This study aims to explore whether ONSD and TCD parameters could assess prognosis for AIS patients noninvasively.Methods: We conducted a prospective study of AIS patients admitted to the intensive care unit of neurology department of the First Hospital of Jilin University.On admission,the ONSD and TCD parameters were obtained at the bedside of the Patient,including the systolic flow velocity（VS）,diastolic flow velocity（Vd）,mean blood flow velocity（Vm）and pulsatility index（PI）of bilateral middle cerebral arteries.At 3-month and 6-month follow-up,patients were grouped according to the Glasgow Outcome Scale（GOS）criteria into a good prognosis group and a poor prognosis group.Two independent samples t-tests were used to compare ONSD in the Poor-Prognosis group and the good-Prognosis group.Univariate and multivariate logistic analyses and receiver operating characteristic curves were used to assess the association between each variable and Prognosis.Results: A total of 82 patients with mean age（65.1 ± 11.0 years;60（73.2%）men）were included.The patients were followed up at 3 months,and 61patients（74.39%）had poor prognosis.The ONSD in the poor prognosis group was significantly greater than that in the good prognosis group（5.41±0.38 VS 4.90±0.30,P<0.001）.Univariate Logistic regression analysis showed that ONSD（P<0.001）,Glasgow coma score（GCS）（P<0.001）0.001)and midline shift（P=0.013）were statistically significant in predicting poor prognosis.However,multivariate logistic regression analysis showed that after adjusting for other factors,ONSD and GCS scores were independent prognostic factors.Every 0.1 mm increase in the mean ONSD was associated with a1.4-fold increased risk of poor prognosis（OR1.4,95 % CI 1.2-1.7,P = 0.001）.Each1-Point increase in GCS score was associated with a 60% lower risk of poor prognosis（OR 0.6,95% CI 0.4-0.8,P = 0.001）.The ROC curve and Youden index calculated the best cut-off value of 5.18 mm for ONSD to predict poor prognosis,with a diagnostic sensitivity of 82.0%,a specificity of 85.7%,and an AUC of 0.872（P < 0.001,95% CI0.786-0.957）.The patients were followed up at 6 months,and 54patients（65.85%）had poor prognosis.The ONSD in the poor prognosis group was significantly greater than that in the good prognosis group（5.45±0.38 VS 4.95±0.32,P<0.001）.Univariate Logistic regression analysis showed that ONSD mean（P<0.001）,GCS（P<0.001）and midline shift（P=0.001）had statistical significance in predicting prognosis.Multivariate logistic regression analysis showed that after adjusting for other factors,ONSD and GCS were independent influencing factors.Every 0.1 mm increase in the mean ONSD was associated with a 1.4-fold increased risk of poor prognosis（OR1.4,95 % CI 1.2-1.7,P < 0.001）.Each 1-Point increase in GCS was associated with a 70%lower risk of poor prognosis（OR 0.7,95% CI 0.5-0.9 P = 0.003）.The optimal cutoff value was 5.21 mm,with a sensitivity of 87.0%,a specificity of 82.1%,and an AUC of 0.862（P<0.001,95% CI 0.772-0.951）.There was no statistically significant difference between TCD parameters in predicting poor prognosis at 3-month and6-month follow-up.Conclusions: Ultrasonic ONSD may be a new Prognostic indicator for outcome of AIS Patients.